Robert Andrew De Wall, LCPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LCPC-4672 Issued in ID

Practice address

444 Hospital Way Ste 477
Pocatello, ID 83201-2744

Phone

(208) 233-7832

Fax

(208) 233-7835

NPI assigned

Nov 4, 2010

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2008

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

Portneuf Valley Family CenterGroup PAC ID 6901807718, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Portneuf Valley Family Center

  • Professional Counselor
  • Pocatello, ID
  • NPI 1174629976

  ID, Professional

  Medicare reassignment Care Compare group NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1288828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786579200000",
    "number": "1114228384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "444 HOSPITAL WAY STE 477",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832012744",
            "telephone_number": "208-233-7832",
            "fax_number": "208-233-7835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "444 HOSPITAL WAY STE 477",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832012744",
            "telephone_number": "208-233-7832",
            "fax_number": "208-233-7835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE WALL",
        "first_name": "ROBERT",
        "middle_name": "ANDREW",
        "credential": "LCPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-11-04",
        "last_updated": "2026-08-13",
        "certification_date": "2026-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "ID",
            "license": "LCPC-4672",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Ann Davis, MOTR/L
• Thomas Vance Davis, D.O.
• Myla Day, LMSW
• Bo Dayton, DO
• Mary Ann Mendoza De Guzman, OT
• Justin Dechon
• McKenzie Jo Decker, DNP
• Sherry Deiter
• Ruth Siobhan Dekker, M.S.N., F.N.P.
• Jacob Delarosa, MD

• All providers in Pocatello, ID
• Professional Counselor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.